How do you treat recurrent implantation problems? An IVF doctor weighs in

As some of us here at TRB HQ know all too well, going through IVF takes a huge amount of energy, time and inner strength. 

So when an embryo transfer doesn’t work, we’d typically want an explanation, along with clear guidance for what to do next, right?

But if this happens more than once, you may hear your doctor mention recurrent implantation failure, or RIF. It’s a difficult, often deeply emotional reality, and it can leave you asking “Why me?” or even, “Did I do something wrong?”

Recurrent implantation failure treatment – it’s possible

The first thing to know is this – it’s never your fault. Implantation is complicated and influenced by many factors, which is why one of the best things you can do is to tap into advice from experienced specialists who can assess your situation and recommend tailored next steps.

For this kind of super specific support, we turn to The Prelude Network® – the largest and fastest-growing network of fertility clinics in the US and Canada. We’ve confirmed and debunked after embryo transfer day by day symptoms as well as unpacked recurrent miscarriage treatment options with their expert team before, so do bookmark those if you haven’t already.

Together with Dr. Michael Strug, reproductive endocrinologist and fertility specialist at Pacific Fertility Center®, we’re explaining the most effective recurrent implantation failure treatment options available today and walking you step by step through their approach.

Over to Dr. Strug.

The recurrent implantation problems IVF definition

Most fertility specialists define recurrent implantation failure as three or more failed embryo transfers involving embryos that have been confirmed as genetically normal (euploid) through preimplantation genetic testing. 

However, RIF can be difficult to define precisely, as individual factors like overall health or other medical conditions can affect the chances of implantation.

Treatment begins with understanding recurrent implantation failure causes

So what causes recurrent implantation failure? Frustratingly, in most cases, there are no clearly identifiable causes, which likely reflect embryo or uterine factors we do not have testing for currently.

This said, when trying to understand recurrent implantation failure causes, I start by looking at three main areas:

1. Lifestyle factors – These include things like diet, exercise, and avoiding harmful substances. For example, improving nutrition and cutting back on alcohol or tobacco can help improve the quality of eggs and sperm, which may increase the chances of success. 
2. Medical conditions – Some health issues, such as obesity or autoimmune disorders that aren’t well-managed, can make it harder for an embryo to implant. Addressing and optimizing these medical conditions before trying another embryo transfer may improve the chances. 
3. Fertility treatment specifics – Sometimes, the way a patient’s body responds during treatment can affect implantation. One common issue is when the lining of the uterus (called the endometrium) is too thin or doesn’t have the ideal pattern for implantation.
   In those cases, we might adjust the medication used to prepare the lining, or recommend surgical procedures to investigate the uterine lining and cavity more closely. 

Tests and diagnostics to ask about

Next, I’d look at reviewing all of your previous cycles, including embryo creation and transfer. This can help us highlight egg, sperm, or uterine factors to improve before the next attempt. 

Common recommended checks include:

• Thyroid and diabetes screening if not done recently.
• Karyotype blood test to look at chromosome health.
• Anti-phospholipid antibody test, since these antibodies can interfere with implantation.
• Hysteroscopy to view the uterus directly and take a sample of the lining to test for chronic endometritis (low-level inflammation).

Most of the time, these tests come back normal. But if something is found, there are specific treatments available that may help improve the chances of a successful pregnancy.

Recurrent implantation failure treatment – evidence-based options

Because, as I’ve mentioned, recurrent implantation failure treatment depends on the cause (or suspected cause), I’ll often begin by making sure overall health and any medical conditions that might affect implantation are well managed.

From there, we’d then look at:

• Optimizing overall health – Managing weight and improving nutrition can help.
• Enhance egg and sperm quality – Lifestyle changes and certain supplements may help.
• Improve the uterine lining – If it’s too thin, medication protocols can be adjusted to encourage better growth.
• Address uterine abnormalities – Polyps, scar tissue, or other issues can be removed surgically.
• Treat chronic endometritis – Antibiotics followed by a retest can confirm the infection has cleared.
• Manage anti-phospholipid antibodies – Blood thinners may be recommended.

What you can control – top action pointers

Because there is so much that won’t be in your control here, it can be helpful to focus on what is. Here are my top three pointers for patients navigating recurrent implantation failure: 

1. Get informed – Don’t hesitate to ask your care team questions. Understanding what might be causing implantation issues and what can be done to help gives you more clarity and control during the process.
2. Focus on your health – Your overall health plays a big role in fertility. Eating a balanced diet and staying active can support both your general wellbeing and your reproductive health.
3. Be cautious with unproven treatments – Some treatments, especially those aimed at the immune system, are marketed to people struggling with RIF. However, many of these aren’t backed by solid research and could even be risky. It’s important to follow evidence-based advice from trusted fertility specialists.

Your mental health is important, too 

This is a really important part of treatment. Feeling out of control is incredibly frustrating and can take a toll on your emotional wellbeing.

To help manage this stress, many people find activities like exercise or meditation helpful, as they can boost natural endorphins and improve mood.

Practicing mindfulness has also been shown to reduce stress, anxiety, and depression, and I’d recommend helpful apps like Insight Timer and Headspace, which offer guided meditation and relaxation exercises.

Should you keep trying? The bottom line 

The answer is, it depends on your situation. IVF treatment can be unpredictable, and embryo transfers are not always successful on the first attempts.

Research shows that true recurrent implantation failure is rare, with about 92% of people becoming pregnant after three or more embryo transfers.

My key takeaway? Whilst repeated failed transfers can be one of the most challenging experiences during fertility treatment and we often won’t find a confirmed cause, it it’s never your fault, and it doesn’t have to be the end of the road with the right testing, a tailored plan, and support from a skilled care team who are willing to try different options.

The Prelude Network® brings together leading fertility clinics across the US and Canada, offering advanced diagnostics, compassionate care, and evidence-based recurrent implantation failure treatment options to give you the best possible chance of success.

Keen to chat through what your options might look like? Find your nearest clinic here.